Diabetes Health

Blood Pressure Control, Diabetes and Coronary Artery Disease Studied

People with hypertension, diabetes, and coronary artery disease who kept their systolic blood pressure lower than 130 millimeters of mercury (mm Hg) did not have better cardiovascular outcomes than those individuals with usual blood pressure control, according to a new study.

The research shows that people with type 2 diabetes and heart disease who were careful to keep blood pressure low did not avoid stroke and heart attacks any better than those with a higher blood pressure reading.

A study in the Journal of the American Medical Association (JAMA) points out that study participants with lower blood pressure actually were more likely to have a heart attack or stroke or die when their blood pressure was maintained under 130 mm Hg.

This finding is compared to patients with typical blood pressure control, putting them in the 130 to 140 mm Hg range. In healthy adults, blood pressure levels of 120/80 mm Hg or lower are recommended.

Fine-Tuning Best Approach for Patients

Rhonda Cooper-DeHoff, Pharm.D., M.S., lead author of the study, says the findings suggest that "lowering blood pressure intensively does not provide any benefit over and above usual blood pressure reduction.” Dr. Cooper-DeHoff is an associate professor at the University of Florida.

She notes that time would be better spent focusing on other heart disease risk factors that can be changed, such as cholesterol or weight.

Some organizations, including the American Diabetes Association, currently recommend that people with diabetes keep their blood pressure under 130/80 mm Hg, but it has been less clear what to recommend for patients with type 2 diabetes plus coronary artery disease.

To this end, the researchers studied data on 6,400 study participants with type 2 diabetes who were age 50 or over and who also had coronary artery disease.

&The participants were part of a larger clinical trial looking at whether certain medication regimens were better than others for preventing heart attacks and other long-term heart problems.

Risk Was Greatest with Very Low Blood Pressure

Volunteers were divided into groups – they received treatment with either a calcium antagonist or beta-blocker followed by angiotensin-converting enzyme inhibitor (ACE inhibitor), a diuretic, or both. The goal was to reach blood pressure levels of 130/85 mm Hg.

Individuals who had blood pressure between 130 mm Hg and 140 mm Hg and those with less than 130 mm Hg had roughly the same rate of cardiovascular events.

And, the results showed that participants with systolic blood pressure under 120 had a 15 percent higher risk of dying than those with the higher blood pressure readings.

Dr. Cooper-DeHoff says at this time there is no compelling evidence to show that lowering systolic blood pressure below 130 mm Hg is beneficial for patients with diabetes.

She suggests that the emphasis should be placed on maintaining systolic blood pressure between 130 and 139 mm Hg while focusing on efforts such as weight loss and healthful eating.

"We don't need to push below 130 so maybe we save a blood pressure medication and save some of those adverse effects associated with extra [blood pressure] medication and concentrate on some other goals that are still important in patients with diabetes," says Dr. Cooper-DeHoff.

Always consult your physician or other healthcare provider for more information.

August 2010

Blood Pressure Facts

Blood pressure is the force of the blood pushing against the artery walls. The force is made with each heartbeat as blood is pumped from the heart into the blood vessels.

The size and elasticity of the artery walls also affect blood pressure. Each time the heart beats (contracts and relaxes), pressure is created inside the arteries.

The pressure is greatest when blood is pumped out of the heart into the arteries or systole. When the heart relaxes between beats (blood is not moving out of the heart), the pressure falls in the arteries or diastole.

Two numbers are recorded when measuring blood pressure. The top number, or systolic pressure, refers to the pressure inside the artery when the heart contracts and pumps blood through the body.

The bottom number, or diastolic pressure, refers to the pressure inside the artery when the heart is at rest and is filling with blood.

Both the systolic and diastolic pressures are recorded as "mm Hg" (millimeters of mercury). This recording represents how high the mercury column is raised by the pressure of the blood.

Blood pressure is measured with a blood pressure cuff and stethoscope by a nurse or other healthcare provider. A person cannot take his or her own blood pressure unless an electronic blood pressure monitoring device is used.

High blood pressure, or hypertension, directly increases the risk of coronary heart disease (heart attack) and stroke (brain attack). With high blood pressure, the arteries may have an increased resistance against the flow of blood, causing the heart to pump harder to circulate the blood.

Usually, high blood pressure has no signs or symptoms. However, you can know if your blood pressure is high by having it checked regularly by your healthcare provider.

Always consult your physician or other healthcare provider for more information.

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